In this interview, Dr. Austin Perlmutter outlines practical, research‑backed nutrition strategies aimed at optimizing brain health for generally healthy adults. He frames brain health as the central driver of overall well‑being and decision‑making, arguing that a diet that supports cognition will also improve quality of life. The conversation proceeds through the three macronutrient groups, emphasizing whole‑food, Mediterranean‑style choices. For protein, he recommends fish, nuts, seeds, poultry, beans, and eggs while limiting red meat. Regarding fats, he highlights olive oil, nuts, seeds, fatty fish, and eggs, stressing the importance of omega‑3 fatty acids and dismissing blanket anti‑fat rhetoric. Carbohydrates are treated as the most variable category: he advises cutting added sugars and highly processed grains, choosing fiber‑rich, minimally processed sources (e.g., buckwheat, quinoa, wild rice), and personalizing intake using tools like continuous glucose monitoring. Beyond macros, Dr. Perlmutter stresses the inclusion of polyphenol‑rich plant foods (tea, coffee, herbs, turmeric), diverse colorful vegetables, prebiotic fibers (Jerusalem artichoke, jicama, dandelion greens, onions, leeks, bananas), and fermented foods (kimchi, sauerkraut, natto, miso, tempeh) to support the gut‑brain axis. Finally, he recommends limiting alcohol to a glass or less per day, challenging the notion of a health‑promoting daily wine glass. Throughout, he emphasizes sustainability, whole‑food focus, and individualized adjustments rather than fad diets or single‑supplement fixes.
So what are some of your favorites, or let's say top 10 strategies for an average healthy individual, relatively healthy individual looking to optimize their health? I know you see a spectrum, but let's look at the optimization place, which would be a lot of my audience.
So yes, as you said, nutrition, it's nuanced, it's controversial. There's going to be people you probably had on that said you need to eat all the meats and other people saying you need to eat all the plants. Other people saying you can't ever touch gluten, other people saying it's all about your gut, forget everything else. The way that I look at this is trying to make sense of nutrition research, which is in some ways a disaster, but it's looking at these major trends and saying, if you look at the big picture as far as what the research is telling us, not this one supplement for this many milligrams, this many days is linked to these benefits in 3 people in this country that I'm gonna tell everyone now you have to take the supplement. So instead, what I look at is what are the recommendations that both seem to hold up scientifically from a pathway biochemical perspective that have been associated with better health across populations and specifically that relate to better brain health. And the reason I say that is if you don't have brain health, the other stuff doesn't really matter. And that might be slightly controversial, but Coming back to my original point, if you wanna enjoy your life, if you wanna be able to think clearly, you wanna be able to connect with other people, that is a brain health issue. Additionally, if you wanna make healthy decisions about anything else, you need the brain on board. So with that in mind, here's how I approach brain healthy diet or just a generally healthy diet. I think just like I said with exercise, the healthy diet is the one that you can sustain. So some people will say, oh, it's the kale smoothie with all these powders and I'm doing a 10-day detox. That's not a healthy diet. A detox is by definition not a healthy diet. You're trying to detox from something. I'm talking about, here's what I would recommend for years, decades as it relates to health benefits. So I'll go through the macronutrients, the carbs, fats, and proteins, and just some of my general thoughts. And we'll start with what is arguably the easiest area, which is proteins.. So there are a number of people who will say, here's how much protein you need. Here's how much protein you don't need. Here's the right source. Here's the wrong source. From what I can tell, the healthiest sources of protein as it relates to brain function, fish, nuts, seeds, poultry, beans, and maybe eggs, and then less red meat. And again, there are people who will say you're totally wrong, Austin. And people who will say you're right on this but wrong on this. I'm saying when you look at the big pictures, what are the things that relate to better brain health? And one of the themes you'll see as I go through this is that it very strongly correlates with what's called the Mediterranean diet. Hmm. Why that's important is if you look at the research on which diets most strongly correlate with brain health, cognition, mood issues, the Mediterranean diet is number one. I don't think that's really contested. So what is the Mediterranean diet? It's very high in whole foods. It's very low in processed foods. So you'll see that theme. If you wanna go and look at best diets for brain health, you'll see Mediterranean diet. So again, proteins, I won't get into how many grams of protein a person needs a day. I think there's a little bit of controversy there, but it probably differs depending on person's age. I would say in general, if you're getting your protein from these sources, that seems pretty solid to me. Let's go to now some of the more controversial stuff and start with fats. There are still many people who are on an anti-fat kick as it relates to the body, as it relates to the brain. I don't think that's as well substantiated as it used to be. I think even as it relates to saturated fat, what you'll see is these large populations where you're not seeing correlations between saturated fat consumption and these negative health outcomes. There's still a ton of research in animals on a high-fat diet and correlation with a number of negative health outcomes. What's important to understand about this is when you give a rat a high-fat diet, that's not the same thing as giving a human a high-fat diet. Usually what they're giving this animal is a bunch of vegetable fats or lard. And that's not in any way what I'm trying to advocate for here because when you look at what humans eat and and the fat consumption that humans eat, that can be hugely different. And going back to the animals for a second, what you'll see is the negative health effects that come from a high-fat diet are very different depending on what that high fat is. So if it's coming from a fish, they don't really exist, the negative health effect. So just talking about eating less or more fat, I don't think is the conversation we should be having as it relates to healthy sources of fat, as it relates to this brain piece of the conversation. Olive oil, nuts, seeds, fatty fish, and eggs. That's where I start part of this conversation and kind of buried in there is the omega-3 fatty acids, which have probably the strongest correlation with brain health and overall health of any sort of fat group. And so those are going to be at higher levels in the nuts, the seeds, the fatty fish, some types of eggs. And I will note I put eggs in both proteins and fats. Obviously they have both fat and protein, Some people will debate whether eggs are super toxic. If you look at the recent studies as it relates to brain health, as it relates to overall health, what you'll find is pretty much neutral. Some of it showing a benefit, but what you pretty much find is people who eat more eggs don't have any downsides for their brain health, don't have any downsides for their heart health, don't have any downsides for general mortality. Why that matters is I think beyond saying that we need certain nutrients that are really good for our brains, we also need to be saying, look, people need to be full and they also need to have options that are not toxic to the brain. And when I look at the most toxic meal of the day for the brain and for the body, that's breakfast. Because for most people, breakfast is basically dessert where they're eating a whole lot of readily digested carbohydrates that convert into sugar or just basically sugar. What we know now is that our metabolic health is directly related to our brain health. Mm-hmm. That having issues with our blood sugar relates to issues with our brain function. So I think eggs are a great alternative to what most people are eating for their breakfast. I know that doesn't necessarily work for people who are vegan, but I do think that for many people is a good option. So that brings us then to the last and most contentious of the groups, and that would be the carbohydrates. Here again, you have people saying, oh, you need less carbs. It's a, a popular conversation. You only have 3 macro groups to, to pick from fats, carbs, and proteins. I feel like every couple of years somebody picks one and says, don't eat this one and picks another one and says, eat more of this one. Yeah. It's like there's only 3 options, but there's a lot of combinations or permutations. And every year somebody comes up with a diet that is don't eat protein, don't eat carbs, don't eat fats, or do eat fats, but only these ones. So I think carbs are super contentious. I eat carbs and there's a number of reasons for that. One maybe important one is that carbs are our sources of dietary fiber. If you're at all concerned about your gut health, that seems essential and people would push back on that. That's where one of the reasons, other reasons would be that when you look at societies that eat a good amount of their calories from carbohydrates, they do great too. So here again, just like with other categories, I think we're talking about quality. So with carbohydrates, generally speaking, I think it's important to look at first thing, reduce intake of added sugars. This is a universal thing. Whether you're a conventional doctor, an integrative doctor, a functional doctor, everyone agrees that added sugar is bad for us. The only people who are out there pushing this isn't a big deal are basically the sugar industry people themselves. So the top tier highest yield thing that a person can do as it relates to carbs is I believe read the labels and try to reduce added sugar, especially in your beverages. Sugar-sweetened beverages of all the carbohydrate sources have the strongest correlation with negative health outcomes. So look at your drinks. There's added sugar in there, which there in general is going to be because on average, this is where sugar hides, cut that. But then look at added sugars in your foods. I think this is a, the lowest hanging fruit of all. Also look for in general carbohydrate sources that are minimally processed. So you cut out the sugars, the next thing to do would be to look at foods that directly turn into sugar when they're digested. So that's your white breads, your white rice, basically all your baked goods, your muffins, your croissants, your danishes. These are things that directly convert into sugar in your body. Again, the point I'd like to make here is that when you look at sugar consumption and your health, what we see is that sugar consumption at high levels is bad for health, but it's the result of it, which is dysregulation in your metabolic health that correlates with things like brain dysfunction. So not only do you need to be careful of added sugars, but you also need to be careful of foods that directly convert into added sugars and stress your metabolic health. So looking to cut out those heavily processed carbohydrate sources, most breakfast foods, cereals, toast, that's all a great example of that. The other thing I would say on this front is, so if you're going to be eating these carbohydrate sources, there's some research indicating that if you eat it with protein and fat sources, it blunts the amount of sugar levels that go up in your bloodstream. So eating a muffin at 8:00 AM on your way to work is different from maybe eating that same muffin in the context of a breakfast that includes some eggs and maybe some other protein sources and some fats that can help blunt that glucose excursion. So here again, a consideration, the carb sources that I tend to eat with some regularity would be kind of the weirder ones, not necessarily wheat, right? Buckwheat is an interesting example of that. Buckwheat is much higher in nutrients than most conventional wheats. Quinoa, One that has gained popularity. If you're gonna eat rice, maybe not white rice, maybe it's wild rice or forbidden rice. These are usually higher in fiber and higher in other nutrients. So it's experimenting with some of the kind of atypical sources of carbohydrates. And then the last thing I'll say on this front is I think of all three of these, the fats, the proteins, and the carbs, the carbs are the ones that I think probably do benefit from personalization the most. One person may eat a piece of toast and have really no major issues with their blood sugar. Another person may eat that and see a huge spike. So I think of all the areas that it may make sense to work with a health practitioner on to get more insight, and this is where something like a continuous glucose monitor becomes interesting, is what carbs do to your blood sugar and do to your health. So those are, those are by definition the macronutrients and how I approach them. A couple other things if you don't mind, just as far as general dietary considerations. So I think eating a diversity of colorful plant-based foods is important. Think that incorporating polyphenols and plant nutrients into your diet is important. And these are nutrients again found in plants that have been linked to a variety of health outcomes including better brain health. Where do you get these? So tea, coffee, not everybody can tolerate coffee, so I'm not saying that's a blanket recommendation, but tea, coffee are big sources. And then herbs, seasonings. So whether that's cloves or rosemary or curcumin, these are, or turmeric, which contains curcumin. These are ways that we can incorporate some of these plant nutrients into our diets, and that might be good for our brain health. And then fiber and fermented foods, these are great for gut health. We're increasingly learning this may be relevant to brain health. So sources of fiber are basically gonna be any plant-based food that you eat, but certain fibers that may be especially beneficial to the brain are what's called prebiotic fibers. And so some examples of those would be Jerusalem artichokes, jicama, dandelion greens, onions, leeks, bananas. So these are fibers that may be especially helpful to our gut and by kind of extension helpful to our brain. And then fermented foods. So kimchi, sauerkraut, natto, for people who tolerate it, miso and tempeh, which are soy-based sources. You can also get fermented condiments. These are also things that are linked to better gut health, which by extension brain health. And the last thing I'll mention, I know this is a kind of a long rambling here. I think alcohol is one that's worthy of consideration. We've for a while now been saying, oh well, a glass of wine a day, it's good for your heart, good for your health. I think that's wrong. I think we will pretty soon be of the mind that alcohol consumption is not great for the brain in any dose. So I think that I'm not gonna be a teetotaler and say don't drink wine, but what I am saying is try to minimize alcohol consumption if you're trying to improve your general quality of life, brain health, et cetera, to a glass or less a day. I think that's my new recommendation. So a lot of things, but I guess that's the general way that I'd approach basic nutritional strategies that have been linked to better brain health.
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